1. Field of the Invention
The present invention relates to a computer based system that diagnoses, establishes severity, and monitors a client's condition and also monitors medical decisions made by the clinician treating the client.
2. Description of Related Art
As shown and discussed in U.S. Pat. Nos. 5,553,609; 5,601,435; 5,471,382; 5,572,421; 5,341,291; 5,558,638; 5,517,405; 5,357,427 and 5,390,238 computer systems are frequently used in the medical industry to collect data. Some of these systems allow data to be collected from a client that is at a location remote from the clinician or other medical personnel. The remotely collected data can be reviewed by clinicians to generate a course of treatment. Even when using computer collected data, however, clinicians may select treatment that diverges from recommended treatment guidelines; to date, no system uses data not entered by the clinician to monitor clinician decisions for concordance with treatment guidelines.
U.S. Pat. No. 5,473,537 issued to Glazer et al. discloses a system and method for collecting psychiatric data and then providing a recommended course of treatment. The data is provided by a client who responds to a number of questions. The recommended treatment is determined from a complex matrix that contains numerical values that are associated with the client's answers. The clinician may review and follow the recommended treatment. The Glazer system still allows the clinician to ignore the recommended treatment and prescribe a different treatment. The Glazer system does not monitor the treatment prescribed by the clinician, and is unable to use treatment guidelines interactively to guide medical decisions. Hence, a clinician may choose to ignore the treatment guidelines and the Glazer system neither records this nor attempts to influence such choices.
To date there has not been developed a system which can both evaluate a client's condition and monitor a treatment prescribed by a clinician. Such a system would be particularly desirable for a Health Maintenance Organization (HMO) that is attempting to provide care according to recommended treatment guidelines. It would therefore be desirable to provide a computer-based system that attempts to influence treatment decisions and is capable of requiring real-time supervisory accession to decisions that diverge from or are not covered by the treatment guidelines.
Traditionally, clinicians diagnose clients based on information obtained in an initial interview. Usually, this information is obtained neither completely nor consistently. Increasingly, medical diagnosis is established based on evaluating the client's condition according to accepted criteria. For example, a clinician should determine if a client has a Major Depression Episode (MDE) by establishing if the client meets the criteria described in the consensus document establishing these criteria, the Diagnostic and Statistical Manual-IV.
It would be desirable to provide a computer based system that could provide a single questionnaire that is used both to diagnose and to determine the severity of the client's condition. Currently, after determining a diagnosis, if a clinician wishes to quantitatively determine the severity of the condition, they must use a separate instrument to measure severity for that diagnosis. In the case of MDE, for example, the clinician might use the Hamilton Rating Scale for Depression (HRS-D) because many diagnostic measures, including the DSM-IV, do not provide a quantitative measure of severity of a diagnosis. Similarly, many severity measures, including HRS-D, do not establish a diagnosis.